Parkinson's disease puts bones, joints at risk

NEW YORK (Reuters Health) - People with Parkinson's disease have an elevated risk of developing fragile bones and fractures over time -- a problem that deserves more attention, according to a new report.

Parkinson's disease is a neurological disorder in which movement-regulating cells in the brain die off or become disabled, leading to symptoms like tremors, rigidity in the joints, slowed movement and balance problems.

What often gets lost is the fact that these symptoms can lead to reduced bone mass and a greater risk of falls -- which together put Parkinson's disease patients at risk of bone fractures and joint injuries.

What's more, Parkinson's makes it more difficult for people to recover from surgery to repair such injuries, according to the new report, published in the Journal of the American Academy of Orthopedic Surgeons.

A key reason that Parkinson's disease patients tend to lose bone mass is that they walk less than people their age without the disorder, explains Dr. Lee M. Zuckerman, an orthopedic surgeon at the State University of New York Downstate Medical Center in Brooklyn.

They also typically spend less time outdoors in the sunlight, which limits their bodies' natural synthesis of bone-maintaining vitamin D.

Lower bone mass, coupled with the disease-related movement and balance problems, puts them at particular risk of falls and injuries.

To help lower this risk, Zuckerman writes, people with Parkinson's disease should have their symptoms managed to the greatest degree possible with medication. They can also try physical therapy to improve their mobility problems, and, when necessary, take measures to maintain their bone density -- like taking calcium and vitamin D supplements or medications designed to protect bone mass.

Parkinson's disease patients should also get advice on simple ways to prevent falls, including how to get up from a seated position in the safest manner or how to use visual cues to stay steady on their feet.

Parkinson's disease patients also face challenges after surgery to repair orthopedic injuries, according to Zuckerman. Symptoms like tremors, he explains, can interfere with their rehabilitation after surgery. In one study, the patients' pain typically improves after surgery, but this their long-term mobility may not.

"Whether this is because the disease is progressing or because the rehabilitation was insufficient is unclear," Zuckerman said in a written statement.

He suggested that Parkinson's disease patients who have orthopedic surgery start physical therapy soon afterward, and that, when necessary, they see various specialists -- such as neurologists and physical rehabilitation specialists -- who can help them with recovery.

"I recommend patients and their families read up on Parkinson's disease so they can prepare themselves for the challenges that come with it," Zuckerman said. "This type of early education is important, because it can prevent these secondary problems from occurring."

SOURCE: Journal of the American Academy of Orthopedic Surgeons, December 2008.